Thursday, November 08, 2012

New POS Code Established at APTA's Urging

APTA's
request for a new place of service (POS) code to indicate that a physical therapist
(PT) delivered services at a patient’s worksite recently was granted by the
Centers for Medicare and Medicaid Services (CMS). Place of service codes are 2-digit
codes placed on health care claims to indicate the setting in which a service
was provided. The new code is available for use effective January 1, 2013, but
will not be effective for Medicare until May 1, 2013.

The new
code, POS 18, is named "place of employment-worksite." Per the description, the code should be used when
physical therapy is delivered at "A location, not described by any other
POS code, owned or operated by a public or private entity where the patient is
employed, and where a health professional provides on-going or episodic
occupational medical, therapeutic or rehabilitative services to the individual."

PTs
delivering services that are appropriately reported using POS codes should
check with payers to determine if they are prepared to accept POS 18.

Examples
of situations in which POS 18 can be used include, but are not limited to:

Job
site analysis to identify potential accommodations – patient present and
participating in the service

Job
coaching to improve biomechanics at the work site – patient present and
participating in the service

Physical
therapy evaluation and treatment at the worksite

Functional
capacity evaluations at the worksite to determine the worker's ability to
perform specific job duties

Currently,
PTs are likely to report POS 99, known as "other place of service,"
when delivering services at the worksite. The addition of POS 18 will enable
PTs, payers, and others using POS code data to more accurately identify where
services are delivered. Health plans can use this information to implement
payment differentials when providers are required to travel in order to deliver
services, and to study the costs and benefits of alternative service delivery
options.

In its
request to CMS for the new POS code, APTA noted that the provision of physical
therapy (and other medical) services at the place of work reduces lost
productivity, enhances the effectiveness of job-specific training, and improves
access to services where transportation and other barriers may exist. The
association also told the agency that workers are more likely to receive the
health care services they need in order to remain productive in the workforce
when services are easily accessible. Additionally, job-specific evaluation and
training services, including job and/or ergonomic analysis, must be performed
at the work site and therefore are not appropriately reported using other place
of service codes (except POS 99, which is nonspecific).

CMS maintains
POS codes used throughout the health care industry. Additional information
about POS codes is available on CMS' website. CMS will publish a change
request in the near future to inform payers of the change. Meanwhile, the
updated list of codes is available here.